Archived: Village Surgery

We carried out an unannounced inspection at The Village Surgery on 25 February 2022. Clinical records reviews were carried out remotely during the same day. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective - Inadequate

Caring - Inadequate

Responsive - Requires Improvement

Well-led - Inadequate

Following our previous inspection on 8 and 9 September 2021, the practice was rated Inadequate overall and for all key questions but caring and responsive. The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Village Surgery on our website at www.cqc.org.uk.

Why we carried out this inspection
This inspection was a comprehensive inspection to follow-up on concerns identified during our inspection on 8 and 9 September 2021. At that inspection we rated the practice as inadequate overall and served the provider with a Notice of Decision with conditions placed on the registration. We followed up on the areas below which were identified at the last inspection:

• The practice was not monitoring all patients on high risk prescription medicines as required.
• Medication reviews were not always completed or fully noted/recorded.
• The practice had no system in place to monitor MHRA alerts.
• No clinical or administrative staff had any training for COVID-19 related infection control, PPE use, testing, knowledge or protocols.
• Staff had not been completing weekly asymptomatic COVID-19 testing.
• Staff did not know how to correctly complete a lateral flow test for COVID-19.
• There were no premises risk assessments or health and safety checks or audits carried out or completed.
• There was no system for identifying, monitoring or communicating internally about vulnerable patients or safeguarding concerns.
• Four clinicians and one receptionist had not completed safeguarding training or completed it to the correct level.
• Not all emergency medicines were stocked.
• The Practice Manager did not know where policies, protocols, audits or general management records were.
• Three whistle-blowers and staff told us that the Practice Manager and/or one of the GP Partners were bullies and regularly shouted at or generally mistreated staff.
• There were no detailed minutes or records of clinical meetings being held between clinical staff.
• There was no agreed business plan for the future of this practice.
• There were no recorded meetings or minutes for the PPG.
• There were no records or audits of staff surveys.
• There were no audits or records of patient survey analysis or feedback.
• There were no audits of complaints and some complaints had not been recorded as having had a response.
• There were no appraisals for any receptionists or administrative staff.
• There were no competency checks completed for any staff.
• Three receptionists and three whistle-blowers told us that there were not enough staff to cope with the administration of the practice.
• Many clinical and non-clinical staff had failed to complete mandatory training.

We found breaches of regulations. The provider was told to:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that patients' assessments, care and treatment are provided effectively.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider was advised to:

• Complete audits of complaints and use this information to drive improvements.
• Complete audits and monitoring of patient feedback and use this information to drive improvements.

On 22 September 2021, The Village Surgery was issued with an urgent notice of conditions on their registration as a service provider in respect of regulated activities, under Section 31 of the Health and Social Care Act 2008. This notice of
urgent suspension of the provider’s registration was given because we believed that a person would or could be exposed to the risk of harm if we did not take this action. The provider had the right to make an appeal to the First-tier Tribunal. The practice remained open with conditions that enable close monitoring of its progress and improvements.

How we carried out this inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently. This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements. This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Inadequate overall

We found that:

• The practice was still not monitoring all patients on high risk prescription medicines as required.
• There were hundreds of overdue medication reviews.
• There were hundreds of overdue monitoring actions for patients with long-term conditions such as diabetes and hypertension.
• The practice had actioned MHRA alerts but still did not have a system to ensure their clinical records evidenced this.
• Some clinical and administrative staff had completed training for COVID-19 related infection control, PPE use, testing, knowledge or protocols.
• Records of weekly asymptomatic COVID-19 staff testing were unorganised and had gaps.
• There were limited premises risk assessments which had not addressed concerns we identified.
• Staff did not know how to support non-English speakers to communicate with the service.
• All clinical treatment rooms were stocked with expired clinical equipment or items.
• All clinical treatment rooms had clinical waste management issues such as overflowing bins or undated disposal containers.
• There was still no system for identifying, monitoring or communicating internally about vulnerable patients or safeguarding concerns.
• Two clinicians and one non-clinical staff member had not completed safeguarding training or completed it to the correct level.
• Not all emergency medicines were stocked.
• The Practice Manager did not know where policies, protocols, audits or general management records were.
• Staff told us that the management team were divided and difficult to communicate with.
• There were records of clinical meetings being held between clinical staff.
• There was no agreed business plan for the future of this practice.
• There were recorded meetings or minutes for the PPG.
• There were records and audits of staff surveys.
• There were no audits or records of patient survey analysis or feedback.
• There were no audits of complaints and some complaints had not been recorded as having had a response.
• Some significant incidents were unresolved and there was no audit or evidence of learning and follow up actions.
• There were appraisals or 1:1s for some staff but we found five staff who had not had received them.
• There were no competency checks completed for any staff although some staff had had 1:1s.
• Clinical and non-clinical staff had failed to complete mandatory training.

We found breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that patients' assessments, care and treatment are provided effectively.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

• Ensure that all patients that do not speak English are supported to access the service;
• Ensure that reception staff demonstrate a caring and supportive attitude to patients.

This service was placed in special measures in September 2021. Insufficient improvements have been made such that there remains a rating of inadequate for The Village Surgery. Therefore we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care